Anatomy - EVAR – Endovascular Repair of an Abdominal Aortic Aneurysm (Bifurcated Graft)

• o Courses craniad on inferior aspect of diaphragm toward its dome
• o Reticular division into several terminal branches

Superior suprarenal artery: adrenal gland

Terminal branches: inferior aspect of diaphragm

• o Courses laterad to the adrenal glands

Terminal branches: adrenal glands

• o Arises at around the level of the first / second lumbar vertebra (L1–2)
• o Right renal artery: courses posterior to inferior vena cava and head of pancreas to right kidney
• o Left renal artery: courses posterior to body of pancreas to left kidney

Inferior suprarenal artery: adrenal gland

• o Arises inferior to the renal arteries/second lumbar vertebra (L2) from the anterior aspect of the aorta
• o Runs over the psoas muscle, ureter and external iliac arteries to the suspensory ligament of the ovary/the deep inguinal ring of the inguinal canal and the testes

Ovarian arteries: ovaries, parts of the uterine tube,

Testicular arteries: testes, epididymides

• o Run laterally posterior to the psoas muscle over the 1st to 4th lumbar vertebrae (L1–4)
• o Anastomose with the arteries of the anterior abdominal wall (superior and inferior epigastric arteries, iliolumbar artery, deep circumflex iliac artery)

Spinal branches: spinal canal

Terminal branches: abdominal wall, muscles of the back

• Along the superior border of the pancreas
• Entry into the splenorenal ligament and spleen

Pancreatic branches:

• Posterior to the pancreas

Dorsal pancreatic artery:

• Posterior to the pancreas
• Anastomoses with the greater pancreatic artery to form the inferior pancreatic artery

Greater pancreatic artery (arteria pancreatica magna):

• Runs caudally posterior to the tail of the pancreas
• Anastomoses with the dorsal pancreatic artery to form the inferior pancreatic artery

Pancreas

Posterior gastric artery:

• Runs cephalad in the phrenicosplenic ligament to the gastric fundus

Stomach (posterior surface of the fundus)

Short gastric arteries:

• Run in the gastrosplenic ligament to the gastric fundus

Stomach (fundus and greater curvature)

Left gastro-omental artery:

• Runs in the gastrocolic ligament to the greater curvature
• Anastomoses with the right gastro-omental artery

Stomach (fundus and greater curvature)

• Runs to the lesser curvature of the stomach
• Anastomoses with the right gastric artery

Direct branches

Stomach (lesser curvature)

Oesophageal branches

Oesophagus

• Runs to the right towards the porta hepatis
• Divides into the proper hepatic artery and the gastroduodenal artery

Proper hepatic artery

• Main branch of the common hepatic artery
• Arises posterior to the pylorus
• Runs in the hepatoduodenal ligament together with the portal vein (vena portae hepatis) and the common bile duct (ductus choledochus) to the porta hepatis
• Gives off 3 branches:

1. Right gastric artery:

• Runs in the lesser omentum to the lesser curvature of the stomach
• Anastomoses with the left gastric artery

Stomach (right lesser curvature)

2. Right hepatic artery

Liver (right part)

Gallbladder (cystic artery)

Part of the caudate lobe

3. Left hepatic artery

Liver (left part)

Part of the caudate lobe

Gastroduodenal artery

• Runs posterior to the lesser omentum towards the pancreas
• Divides into 2 branches:

1. Right gastro-omental artery:

• Runs to the greater curvature
• Anastomoses with the left gastro-omental artery

Pancreas, duodenum, stomach

2. Anterior and posterior superior pancreaticoduodenal arteries:

• Together with branches of the inferior pancreaticoduodenal artery, form a vascular plexus around the head of the pancreas

• Runs cephalad in the region of the horizontal part of the duodenum (pars horizontalis duodeni) to the head of the pancreas

Anterior and posterior branch:

• Anastomose with the anterior and posterior pancreaticoduodenal artery

Head of the pancreas

• run within the mesenteric root towards the jejunum and ileum
• form vascular arcades among themselves

Aa. rectae

Jejunum, ileum

• runs within the mesentery towards the ileocaecal region

Anterior and posterior caecal artery

Caecum

Appendicular artery (variant: arising from the posterior caecal artery)

Appendix vermiformis

• runs within the ascending mesocolon towards the ascending colon

divides into 2 branches that anastomose with the middle colic artery and the ileocolic artery respectively

Ascending colon

• runs within the transverse mesocolon towards the transverse colon

divides into 2 branches: the right branch anastomoses with the right colic artery (right flexure), the left branch anastomoses with the left colic artery (left flexure)

Transverse colon

• runs within the descending mesocolon towards the descending colon

divides into 2 branches that anastomose with the middle colic artery and the sigmoid arteries respectively

Descending colon

• 2–4 arteries forming a vascular arcade within the sigmoid mesocolon
• anastomose with the left colic artery and the superior rectal artery

several small branches to the sigmoid colon

Sigmoid colon

• approaches the rectum from posteriorly
• anastomoses with the middle rectal artery

several small branches to the rectum

upper rectum